Hyun Soo Lee, Han Ki Park, Sang On Lee, Yu Rim Shin
Severance Cardiovascular Hospital and Yonsei University College of Medicine.
Republic of Korea
Frontiers in Surgery
Front Surg 2026; 13:
DOI: 10.3389/fsurg.2026.1820935
Abstract
Objectives: Postoperative pulmonary vein stenosis (PVS) is an uncommon but potentially serious complication following pediatric heart transplantation. This study aimed to determine the prevalence of PVS and identify donor- and recipient-related predictors.
Methods: We retrospectively reviewed pediatric patients (<18 years) who underwent heart transplantation at a single center between 2003 and 2024. PVS was defined as a ≥ 4 mmHg Doppler gradient across any pulmonary vein on echocardiography or significant narrowing on computed tomography. Donor and recipient variables-including congenital heart disease (CHD), predicted heart mass (PHM), donor-recipient size/sex were analyzed using univariate and multivariable logistic regression. The primary endpoint was the occurrence of PVS; the secondary endpoint was overall mortality.
Results: Among 50 recipients (median age, 11 years; range, 0.2-17 years), 9 (18%) developed de novo PVS with a median time to diagnosis of 84 days (range, 4-1088 days). On univariate analysis, CHD (p = 0.007), PHM (p = 0.017), and male-to-female donor-recipient mismatch (p = 0.035) were significantly associated with PVS. In multivariate analysis, CHD remained the only associated factor (p = 0.015; OR, 11.25; 95% CI, 1.60-78.98). PVS did not significantly affect survival probability (p = 0.240).
Conclusions: PVS occurred in nearly one-fifth of pediatric heart transplant recipients, predominantly in those with CHD. However, given the limited sample size, these findings should be considered exploratory and hypothesis-generating. Donor-recipient size mismatch parameters were consistently greater among patients with PVS, though this association warrants validation in larger prospective cohorts. Although PVS was not associated with increased mortality, identification of high-risk groups remains essential for surveillance and preventive strategies in pediatric heart transplantation.
Category
Stenosis or Obstruction of Pulmonary Veins Following Heart or Lung Transplantation
Incidence or Prevalence of Disease
Patient Factors Influencing the Onset, Severity or Outcome of Disease
Year of Publication: 2026
Age Focus: Pediatric
Article Type: Retrospective Observational Cohort Studies (>10 patients)
Article Access: Free PDF File or Full Text Article Available Through PubMed or DOI: Yes